Disturbed Kids Stuck In Emergency Room Limbo

Today, in Hartford, I see 16 children traversing the all-too-familiar tortuous path of mental illness, failing to receive the care they most desperately need.

Yet how can this be, in the immediate aftermath of the most horrific of events in our own state?

How can this be only a few short days after President Obama implored us to do everything possible to protect our children and to prevent another Newtown tragedy?

How can this be, as we are so vividly reminded of the unquestionable relationship between mental illness and violent behavior?

I am the physician-in-chief at Connecticut Children's Medical Center. Because of my training in the field of developmental and behavioral pediatrics, I am particularly sensitive to emotional disorders and the dysfunction rampant within our behavioral health system.

However, no specialized training can prepare me or my colleagues for the daily onslaught of children with severe behavioral problems who are continuously brought to our emergency department in ever-increasing frequency.

As I prepare this commentary, 16 children are in our emergency department — a unit designed to address the medical and surgical needs of ill children in an institution that is not licensed to provide psychiatric inpatient care. They sit in an unconscionable and unhealthy limbo, awaiting mental health evaluation to determine their needs.

Ironically, these children include some who are unable to be managed in a state psychiatric facility, because they're too aggressive and difficult to handle, and are therefore shipped to our general emergency department for care.

For those requiring hospitalization, access to psychiatric inpatient beds may take days to weeks, depending on the availability of beds and the proclivities of our state agencies, hospital administrators and managed-care plans. How can this be?

Our state has taken a number of steps to alleviate this mental health crisis and address the chronic gaps in our behavioral health system.

•A program called CARES (Child and Adolescent Rapid Evaluation and Stabilization unit) sits on the adjacent Institute of Living campus, able to receive a modest number of patients requiring extended evaluation and stabilization while awaiting discharge or hospitalization.

•Also, emergency psychiatric services may be summoned by a phone call, and mental health clinicians will be sent to homes, schools and other venues to provide acute intervention.

•Enhanced-care clinics facilitate the referrals of children with emotional problems from primary care providers to behavioral health clinicians.

The beneficial impact of all these commendable and important initiatives is undeniable. Yet despite such efforts, the number of children referred to our emergency department, only to be stockpiled awaiting disposition, continues to grow, year after year, at an alarming rate.

At this moment, our emergency department, with its capacity of 26 beds and a four-bay fast-track unit, is attempting to treat 16 patients in behavioral health crisis, while also providing care to 20 medical-surgical patients in examination rooms, as 18 patients await care in the waiting room, four patients are in the halls on stretchers, and four other patients are being seen in our adjacent primary care center.

How can we be so lacking in the capacity to respond to the urgent needs of these patients?

Yet today, in the midst of this distress, a call to the head of a state agency yields no immediate assistance. State directors responsible for authorizing care when a proper facility is identified with the capacity to relieve some of this gridlock, refuse authorization of such care. How can this be?

While many contributing factors will undoubtedly be identified, Newtown will unquestionably be seen as a consequence of untreated mental illness. Our response to children with serious emotional illness continues to be deploringly inadequate.

Today, I see 16 children traversing the treacherous path of mental illness, failing to receive the services they need. How can this be?

Paul Dworkin, M.D., is physician-in-chief at the Connecticut Children's Medical Center and professor and chairman of pediatrics at the University of Connecticut School of Medicine.